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Psychopharmacology is a tool used in the pediatric setting to help patients gain relief from emotional and behavioral distress while aiding their coping and adaptation to physical illness and medical or surgical treatments. High rates of comorbidity between childhood psychiatric and physical disorders ensure that psychopharmacological issues will present in pediatric settings ranging from the primary care clinician's office to the critical care unit (Spady et al. 2005; Stoddard et al. 2006).

Little literature is available to guide psychotropic prescribing in physically ill children and adolescents. Significant interindividual responses should be expected across medication classes (Cutler et al. 2008; Li et al. 2008). Further limitations arise when addressing situations involving young children, for whom case reports often are the only existing literature (Gleason et al. 2007). Careful monitoring within a clinical relationship that supports the collection of valid and reliable data on treatment ef fects should be the current standard of care (Myers and Winters 2002).

When present, physical disease factors that produce psychiatric symptoms should be treated directly. Often, distressing cognitive, emotional, and/ or behavioral symptoms experienced by physically ill children do not meet full diagnostic criteria for a discrete mental disorder yet nevertheless impair functioning and interfere with recovery. These symptoms are targets for medication intervention when there is no response to available evidence-based psychosocial interventions, there is a significant risk of harm, or there is significant functional impairment (Gleason et al. 2007). Commonly encountered target symptom dimensions include agitation, anxiety, disorientation, perceptual disturbance, insomnia, fatigue, mood dysregulation, and pain (Galloway and Yaster 2000).

The choice of medication should be guided by an understanding of developmental pharmacokinetics and pharmacodynamics, desired medication effects, potential adverse effects, risks of drug interactions, available nonpharmacological treatment options, and interplay of medications with disease processes.

Informed consent should be obtained prior to treatment and should include a developmentally informed discussion with patients and families of the indications, therapeutic alternatives, anticipated benefits, and potential risks of medication (Frank et al. 2008). This discussion should note the U.S. Food and Drug Administration regulatory status for an intended use and any special warnings. Care must be taken to maximize participation and understanding on the part of the patient and his or her parents and health care providers.